Ventilation/perfusion (V/Q) scanning in contemporary patients with pulmonary embolism: utilization rates and predictors of use in a multinational study.
Por:
Bonnefoy PB, Prevot N, Mehdipoor G, Sanchez A, Lima J, Font L, Gil-Díaz A, Llamas P, Aibar J, Bikdeli B, Bertoletti L and Monreal M
Ahead of Print:
5 oct 2021
Resumen:
Ventilation/perfusion (V/Q) imaging and computed tomography pulmonary angiography (CTPA) are common tools for acute pulmonary embolism (PE) diagnosis. Limited contemporary data exist about the utilization of each modality, including the predictors of using V/Q versus CTPA. We used the data from patients diagnosed with PE using V/Q or CTPA from 2007 to 2019 in Registro Informatizado Enfermedad ThromboEmbolica, an international prospective registry of patients with venous thromboembolism. Outcomes was to determine the trends in utilization of V/Q vs. CTPA and, in a contemporary subgroup fitting with current practices, to evaluate predictors of V/Q use with multivariable logistic regression. Among 26,540 patients with PE, 89.2% were diagnosed with CTPA, 7.1% with V/Q and 3.7% with > 1 thoracic imaging modality. Over time, the proportional use of V/Q scanning declined (13.9 to 3.3%, P < 0.001). In multivariable analysis, heart failure history (odds ratio [OR]:1.5; 95% confidence interval [CI] 1.14-1.98), diabetes ([OR 1.71; 95% CI 1.39-2.10]), moderate and severe renal failure (respectively [OR 1.87; 95% CI 1.47-2.38] and [OR 9.36; 95% CI 6.98-12.55]) were the patient-level predictors of V/Q utilization. We also observed an influence of geographical and institutional factors, partly explained by time-limited V/Q availability (less use over weekends) and regional practices. Use of V/Q for the diagnosis of PE decreased over time, but it still has an important role in specific situations with an influence of patient-related, institution-related and logistical factors. Local and regional resources should be evaluated to improve V/Q accessibility than could benefit for this population.
Filiaciones:
Bonnefoy PB:
Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France.
Prevot N:
Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France
INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France
Mehdipoor G:
Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA
Cardiovascular Research Foundation (CRF), New York, NY, USA
Sanchez A:
Service de Médecine Nucléaire, CHU de Saint-Etienne, 42055, Saint-Étienne, France
Lima J:
Department of Pneumonology, Hospital Universitario de Valme, Sevilla, Spain
Font L:
Department of Haematology, Hospital de Tortosa Verge de La Cinta, Tarragona, Spain
Gil-Díaz A:
Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain
Llamas P:
Department of Haematology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
Aibar J:
Department of Internal Medicine, Hospital Clínic, Barcelona, Barcelona, Spain
Bikdeli B:
Department of Medicine, Peconic Bay Medical Center, Northwell Health, Riverhead, NY, USA
Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, USA
Bertoletti L:
INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, 42055, Saint-Etienne, France
Service de Médecine Vasculaire Et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
INSERM, CIC-1408, CHU Saint-Etienne, 42055, Saint-Etienne, France
F-CRIN INNOVTE Network, Saint-Etienne, France
Monreal M:
Department of Internal Medicine, Hospital Universitari Germans Trias I PujolBadalona, Barcelona, Universidad Católica de Murcia, Barcelona, Spain
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